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Scotland’s Health: “Facts are stubborn things, but statistics are pliable.”

Winter is the season that puts the most pressure on NHS Scotland with 2017 being particularly bad over the Festive season due to flu and other respiratory illnesses.

NHS Scotland issue weekly performance statistics which are not a particularly good way to assess any organisation as one week can be not ‘typical’. Of slightly more use is looking at a month. The following statistics are for November in 2016,2017 and 2018. They are for the A&E Departments in Scotland’s hospitals which seem to attract the most negative attention from many politicians intent on criticising the hard work being done by NHS Scotland workers.

During the month of November 2018:

There were 135,166 attendances at A&E services in Scotland.

91.3% of attendances at A&E services were admitted, transferred or discharged within 4 hours.

1,218 (0.9%) patients spent more than 8 hours in an A&E department.

210 (0.2%) patients spent more than 12 hours in an A&E department.

25.6% of attendances led to an admission to hospital.

During the month of November 2017:

There were 132,218 attendances at A&E services in Scotland.

93.3% of attendances at A&E services were seen and resulted in a subsequent admission, transfer or discharge within 4 hours

929 (0.7%) patients spent more than 8 hours in an A&E department

218 (0.2%) patients spent more than 12 hours in an A&E department

25.6% of attendances led to an admission to hospital

During the month of November 2016:

There were 129,233 attendances at A&E services across Scotland.

93.6% of attendances at A&E services were seen and resulted in a subsequent admission, transfer or discharge within 4 hours.

730 (0.6%) patients spent more than 8 hours in an A&E department.

131 (0.1%) patients spent more than 12 hours in an A&E department.

26% of attendances led to an admission to hospital.

What the figures show is not much change really in waiting times with more than 9 out of 10 patients being seen and processed within 4 hours. The 4 hours is not just the time to be seen it includes all the tests and consultations required leading to the patient getting the treatment most suitable for them.

So let’s look at another area which is often flagged up by those wishing to slag off NHS Scotland. Cancelled operations – and taking the same month, November.

Again there really is not much of a difference over the 3 years in November. The cancellations in operations in November 2018 for non-clinical reasons shows a high of 996 (3.4%) and this was when there was an unplanned, temporary closure of the Cowlairs decontamination unit in NHS Greater Glasgow & Clyde. Cowlairs is the central decontamination unit supplying Glasgow hospitals. Its temporary closure meant that some operations had to be rescheduled.

This is a further example of why looking too closely at figures of a limited period of time be it a week or even a month can give the wrong impression of our NHS.

Statistics taken over a longer period are of much more use particularly when dealing with the issue of the nation’s health and wellbeing which cannot be found from looking at one week’s A&E stats.

Public Health

What is concerning is that despite efforts to improve public health through early detection and preventative methods the areas of Scotland with the most deprivation are the least likely to participate in these initiatives.

The bowel screening test kit so easy to use and done in your own home has a decreasing uptake at 55.6% but in areas of deprivation it is only 42.3%.

For patients diagnosed with breast, colorectal or lung cancer in the most deprived areas of Scotland, the highest proportion were diagnosed at the most advanced stage of disease – stage 4 (30.3%) . This is actually an improvement.

For children in the most deprived areas there is a higher rate of obesity. The cost and availability of fresh fruit, vegetables and quality food products severely limits what those on a low income can afford to buy. A family already paying increased heating costs and rent will choose to buy cheaper less healthy foods.

Breastfeeding rates are gradually increasing in Scotland with 42% at 6 – 8 weeks . This is low compared to similar countries and is even lower in Scotland’s deprived areas. The universality and successful uptake of the Baby Box scheme may go some way to improving these stats for breastfeeding and baby care. Amongst the contents of The Baby Box are quality clothing, a thermometer and information. Most importantly it encourages communication between parents, midwives and support groups when you may be struggling with something like breast feeding. It is quite inexplicable why some politicians object to such an important advance in tackling Scotland’s support for parents and babies.

NHS Scotland is successful – it is not perfect and should be improved but constant attacks by some politicians who (perhaps deliberately) use performance statistics to belittle the amazing complex work it does to keep us all alive only serves to show how little they understand the need to improve the health of the whole nation.

Scotland has done much in the way of preventative measures to improve health but with increasing rates of poverty improving the heart of the nation’s health will take a momentous change. Until the inequalities in our society are addressed we will not solve the inequalities in the nation’s health.

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I started doing ‘O’ level Statistics – did one term, and realised that they can be cleverly manipulated to serve the purpose of who ever is presenting them. I stopped doing the course, and have mistrusted statistics ever since, as being a potentially dishonest discipline. As with many things, they are useful if used properly – as they are meant to be used – otherwise, to quote someone – I can remember who …
“The are three kinds of lies – Lies, Damn lies, and Statistics.”
Beware of statistics – approach with caution and scrutinize them, carefully, especially when they are presented to you by someone who you know wants you to see things how they want you to see things, rather than how things are. They can be very, very dodgy things, statistics.
Put them under the magnifying glass of truth!

It is a cynical attempt at scare mongering! To use our health service this way is shameful and disrespects our hardworking NHS staff. Of course money is always needed, it was ever thus, but this is shameful fear tactics.

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